Abstract
<h3>Purpose</h3> Cardiac mass ratio (CMR) is validated for donor-recipient sizing, and as a predictor of transplant outcomes. However, there is a lack of data reviewing the role CMR plays in transplant recipients with pulmonary hypertension (pHTN). In particular, the right ventricular (RV) mass ratio (RVMR) is a component of CMR not yet studied separately for this purpose. We aimed to review the relationship of CMR and RVMR with pHTN in terms of development of primary graft dysfunction (PGD) and overall survival. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was queried for primary heart transplant patients from 1987 to 2020. Missing data was imputed using a Bayesian network. Left ventricular (LV), RV, total cardiac mass (CM), and their ratios were calculated for donors and recipients. Relevant hemodynamic variables were included in logistic regression and cox proportional-hazards models to evaluate a relationship to PGD and overall survival. A stepwise regression created parsimonious models. Covariates with statistically significant relationships to the outcomes were included in tensor product spline models. <h3>Results</h3> 62,169 patients were identified. A parsimonious logistic model for odds of PGD included RVMR (OR 0.99, p<0.001) and mean PAP (mPAP) (OR 1.00, p<0.001). A parsimonious cox model for survival included diastolic PAP (HR 1.01, p<0.001), systolic PAP (HR 1.01, p<0.001), mPAP (HR 0.98, p<0.001), transpulmonary gradient (TPG) (HR 1.01, p<0.001), and CMR (HR 0.76, p<0.001). A tensor product spline model evaluating PGD demonstrated increasing odds of PGD in patients with elevated mPAP and smaller RVMR (Figure, p<0.001). Comparable models evaluating overall survival demonstrated smaller CMR was associated with reduced survival at elevated mPAP (p<0.001) and TPG (p<0.001). <h3>Conclusion</h3> In patients with pHTN, RVMR is significantly associated with odds of developing PGD, and CMR is with overall survival. Some RV oversizing may be beneficial to mitigate the risk of PGD.
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